Effects of percutaneous cryoablation for renal tumor on overall and split renal function.

PURPOSE: To evaluate retrospectively the influence of percutaneous cryoablation for small renal tumors on total and affected kidney function and risk factors associated with worsening function of the affected kidney. MATERIALS AND METHODS: Between April 2016 and March 2022, 27 patients who underwent cryoablation for small renal tumors at our institution participated in this study, which investigated time-dependent changes in postoperative renal function. We evaluated estimated glomerular filtration rates (eGFRs) and split renal function revealed by scintigraphy using 99 m technetium-mercaptoacetyltriglycine (99mTc-MAG3) before cryoablation and at 1 week, 1 month, and 6 months after cryoablation. Numerous variables were analyzed to assess risk factors for worsening renal function. RESULTS: Baseline eGFR (mean ± standard deviation) was 56.5 ± 23.7 mL/min/1.73 m2 (mean ± SD; range, 20.5-112.5). Mean eGFRs at 1 week, 1 month, and 6 months after cryoablation were 57.4 ± 24.5 (19.1-114.9), 57.1 ± 25.1 (21.5-114.9), and 53.8 ± 23.9 mL/min/1.73 m2 (20.0-107.5), respectively. Changes were statistically insignificant (p = 1.0000, = 0.6749, and = 0.0761, respectively). Regarding split renal function, mean baseline contribution of the affected kidney determined by 99mTc-MAG3 was 49.7% ± 6.0% (38.8-63.3%); these rates at 1 week, 1 month, and 6 months after cryoablation were 43.7% ± 8.8 (29.1-70.6%), 46.2% ± 7.7% (32.6-70.3%), and 46.0% ± 8.5% (32.5-67.6%), respectively. Differences from baseline were significant for all periods (p < 0001, < 0001, = 0.0001, respectively). Serum C reactive protein and lactate dehydrogenase at 1 day following cryoablation, tumor's nearness to the collecting system or sinus, and volume of ablated normal renal parenchyma were significantly correlated with decreased contributions of the affected kidney by > 10% after cryoablation. CONCLUSION: Unlike total renal function, affected kidney function could worsen after cryoablation.

Three cases of recurrences after stent-graft placement for arterio-visceral/arterio-luminal fistulas in long-term follow-up.

We report 3 patients with recurrences after stent-graft placement for arterio-visceral/arterio-luminal fistulas in long-term follow-up. Two patients had ureteroarterial fistulas and the other had a tracheo-innominate artery fistula. All 3 patients had hemorrhage on initial presentation and underwent a stent-graft placement for an arterio-visceral/arterio-luminal fistula. Recurrences occurred over a period of 8-26 months and were diagnosed by contrast-enhanced computed tomography; pseudoaneurysms were found in contrast-enhanced computed tomography images in all cases. Pseudoaneurysms may be noted on contrast-enhanced computed tomography as the only finding of recurrences during long-term follow-up after stent-graft placement for arterio-visceral/arterio-luminal fistulas.

Analgesic efficacy and safety of percutaneous thermal ablation plus cementoplasty for painful bone metastases: a systematic review and meta-analysis.

PURPOSE: To conduct a systematic review and meta-analysis of publications to evaluate the analgesic efficacy and safety of percutaneous thermal ablation (PTA) plus percutaneous cementoplasty (PCP) (PTA + PCP) for painful bone metastases. METHODS: We searched PubMed, Cochrane Library and Embase for articles published up to October 2022. Outcomes were a 10-point pain scale, morphine equivalents daily dose (MEDD) and complications. A subgroup confined to spinal bone metastases was analyzed. RESULTS: Twenty-one articles were selected for the analysis. The 21 selected articles involved a total of 661 cases. The pooled pain scales at pre-PTA + PCP, 1 day, 1 week and 1-, 3-, and 6 months post-PTA + PCP were 7.60 (95% confidence interval [CI], 7.26-7.95, I2 = 89%), 3.30 (95% CI, 2.25-4.82, I2 = 98%), 2.58 (95% CI, 1.99-3.35, I2 = 94%), 2.02 (95% CI, 1.50-2.71, I2 = 93%), 1.78 (95% CI, 1.26-2.53, I2 = 95%), and 1.62 (95% CI, 1.14-2.31, I2 = 88%), and in the subgroup, 7.97 (95% CI, 7.45-8.52, I2 = 86%), 3.01 (95% CI, 1.43-6.33, I2 = 98%), 2.95 (95% CI, 1.93-4.51, I2 = 95%), 2.34 (95% CI, 1.82-3.01, I2 = 68%), 2.18 (95% CI, 1.57-3.03, I2 = 78%), and 2.01 (95% CI, 1.16-3.48, I2 = 86%). Mean MEDD decreased up to 3 months post-PTA + PCP in 4 articles. The overall pooled major complication rate was 4% (95% CI, 2-6%, I2 = 2%). CONCLUSIONS: The updated systematic review and meta-analysis indicates that PTA + PCP for painful bone metastases is safe, and can lead to rapid and sustained pain reduction.

Difference in arterial FDG accumulation in healthy study participants between digital PET/CT and standard PET/CT.

OBJECTIVE: To evaluate the differences in FDG accumulation in arteries throughout the body between digital and standard PET/CT. METHODS: Forty-six people who had FDG-PET examinations with a digital PET/CT scanner for health screening between April 2020 and March 2021 and had previous examinations with a standard PET/CT scanner were the study participants. FDG accumulation in arteries throughout the body was visually assessed in each segment. Scan was considered positive when arterial FDG accumulation was equal to or greater than that of the liver. The positivity rates for general arteries and each arterial segment were compared between the two kinds of scanners. If any one of the arterial segments was considered positive, the general arteries were classified as positive. Moreover, the rate of change in results from the standard PET/CT to the digital scanner in the same individual (negative to positive, positive to negative) was examined. RESULTS: In the evaluation of general arteries, the positivity rates were 21.7% (10 cases) for the standard PET/CT, whereas positive rates were 97.8% (45 cases) for the digital PET/CT (p < 0.001). In all arterial segments, the positivity rate was significantly higher with the digital PET/CT compared to the standard PET/CT; those with the digital PET/CT were, respectively, 95.7%, 87.0%, 73.9%, 37.0%, 34.8%, and 21.7% in the femoral, brachial, aortic, subclavian, iliac, and carotid arteries. On the other hand, those with the standard PET/CT were 13.0%, 13.0%, 19.6%, 2.2%, 0%, and 4.4% in segments in the above order. Changes from negative to positive were shown in many cases; 35 cases (76.0%) of general arteries, 38 cases (82.6%) for the femoral artery, and 34 cases (73.9%) for the brachial artery. The exception was one case in which a change from positive to negative was confirmed in the carotid artery. In all arteries considered to be positive, FDG accumulation was not greater than but was equal to that in the liver with both scanners. CONCLUSIONS: Arterial FDG accumulation was significantly higher with digital PET/CT compared to conventional PET/CT. With digital PET/CT, an arterial FDG accumulation equal to the liver may not to be considered as abnormal accumulation.

Spontaneous regression of small cell lung cancer associated with Lambert-Eaton Myasthenic Syndrome: Case report.

Spontaneous regression (SR) of cancer is very rare, especially of small cell lung cancer (SCLC). Recently, an association of paraneoplastic neurological syndrome (PNS) has been reported as a cause of SR of cancer, and onconeural antibodies are a possible factor in the SR of cancer associated with PNS. We herein report the first case of SR of SCLC combined with anti-P/Q-type of voltage-gated calcium channel (VGCC) antibody-positive Lambert-Eaton myasthenic syndrome (LEMS), a subtype of PNS. This case report suggests that SCLC may be spontaneously reduced by an autoimmune response induced by VGCC antibodies associated with LEMS. Our finding may help elucidate the mechanisms that inhibit tumor growth and cause the regression of tumors.

Guidelines for Central Venous Port Placement and Management (Abridged Translation of the Japanese Version).

The central venous port has been widely used for patients who require long-term intravenous treatments, and the number of palcement has been increasing. The Japanese Society of Interventional Radiology developed a guideline for central venous port placement and management to provide evidence-based recommendations to support healthcare providers in the decision-making process regarding the central venous port. The guideline consisted of two parts: (i) a comprehensive review of topics including preoperative preparation, techniques for placement or removal, complications, and maintenance methods and (ii) recommendations for the six clinical questions regarding blood vessels for central venous port placement, port implantation site, prophylactic antibiotic therapy, imaging guidance for puncture, disinfectant prior to accessing the central venous port, and the optimal procedure at the end of drug administration via the central venous port, generated on the basis of the rating quality of evidence by systematic review.

A case of pulmonary pleomorphic carcinoma associated with cystic airspace.

Lung cancer associated with a cystic airspace is frequently misdiagnosed or overlooked. Adenocarcinoma, followed by squamous cell carcinoma, is the most typical histologic type of lung cancer connected to a cystic airspace. Here we present the rare case of lung pleomorphic carcinoma associated with a cystic airspace. We encountered a 74-year-old Japanese man diagnosed by computed tomography (CT) as having a nodule outside a cystic airspace in the lung. Several previous CT images showed that the cystic airspace preceded the nodule. Postsurgery, pathology indicated a diagnosis of pleomorphic carcinoma. Since pulmonary pleomorphic carcinomas pursue an aggressive clinical course, their early detection may contribute to an improved prognosis. Our case demonstrated that pleomorphic carcinoma can arise with cystic airspaces. For early diagnosis of those aggressive lung cancers, chest physicians should carefully examine the walls of cystic airspaces on CT.

Stent-Graft Placement and Coil Embolization for Splenic Artery Aneurysm Derived from Isolated Spontaneous Celiac Artery Dissection.

We encountered a case of complex isolated spontaneous celiac artery dissection with a patent false lumen with both entry and re-entry and extensive aneurysmal degeneration of the splenic artery. The dissection entry was wide and was located at the origin of the celiac artery. The false lumen extended to the distal part of the splenic artery, obstructed the true lumen, and was connected to the true lumen at the splenic hilum via the re-entry. Treatment was successful by stent-graft placement for the occlusion of the entry and embolization of the re-entry with microcoils via the false lumen of the splenic artery.

Symptomatic Chronic Severe Stenosis of the Iliac Vein Successfully Treated Endovascularly Using an Interventional Radiology Computed Tomography System.

We report a woman with chronic severe stenosis of the left common and external iliac veins and severe post-thrombotic syndrome symptoms. We successfully recanalized the stenotic segment via interventional radiology, which immediately relieved the symptoms. The interventional radiology computed tomography system was helpful for the safe and precise performance of endovascular treatments.

Predicting the pathological invasiveness of early lung adenocarcinoma prior to surgery using Deauville criteria: reliability and validity.

PURPOSE: This retrospective study aimed to investigate the validity and reliability of FDG-PET/CT visual assessment using Deauville criteria to predict pathological invasiveness of early lung adenocarcinoma prior to surgery. MATERIALS AND METHODS: Between April 2020 and January 2022, 51 patients who underwent surgery for pathological stage 0/I lung adenocarcinoma were enrolled. The pulmonary lesions were divided into two groups according to pathological invasiveness: less invasive (including adenocarcinoma in situ and minimally invasive adenocarcinoma and invasive adenocarcinoma. We compared CT size (total and solid size), SUVmax, and Deauville score between the two groups. Furthermore, we investigated inter-rater and intra-rater agreements regarding the Deauville score. Receiver operating characteristic (ROC) curve analysis was performed to identify the diagnostic performance of each method. RESULTS: Based on pathologic diagnoses, 51 lesions in the 51 patients were divided into 6 less invasive and 45 invasive adenocarcinoma lesions. According to quadratic-weighted Kappa statistics, inter-rater (k = 0.93) and intra-rater (k = 0.97) agreements among all five components of the Deauville score indicated high agreement. There was a statistically significant difference in CT solid size, SUVmax, and Deauville score between the two groups. There were no significant differences between CT solid size and FDG-PET/CT assessments (AUC = 0.93 for Deauville score and SUVmax, AUC = 0.84 for CT solid size). CONCLUSION: FDG-PET/CT visual assessment using the Deauville score could assist in deciding upon minimally invasive surgery for early lung adenocarcinoma.

Removal of central venous port-catheter by the combination of interventional radiological procedures.

We encountered a patient with an infection related to an implanted central venous port-catheter that necessitated removal of the system. As the catheter had tightly adhered to the venous wall, removal was impossible with standard methods. After trial and error, we used a guiding catheter that was advanced over the implanted catheter to detach the fibrin sheath on the implanted catheter that had adhered to the vessel wall. At that time, a pull-through technique was used. After we succeeded in detaching the adhesion with the guiding catheter, we were able to withdraw the implanted catheter.

Computed tomography-guided single celiac plexus neurolysis analgesic efficacy and safety: a systematic review and meta-analysis.

PURPOSE: To perform a systematic review and meta-analysis of published studies to evaluate the analgesic efficacy and safety of computed tomography (CT)-guided single celiac plexus neurolysis (CPN) with the injection of a neurolytic agent into the celiac plexus in one session (CT-guided single CPN). METHODS: PubMed, the Cochrane Library, and Ichushi-Web were searched for English or Japanese articles published up to February 2022, which reported findings about patients who underwent CT-guided single CPN. The outcome measures assessed in the systematic review and meta-analysis were the pain measurement scales from 0 to 10 before and after the intervention and the rate of minor and major complications. RESULTS: The pooled pain measurement scales at pre-intervention and 1- or 2-, 7-, 30-, 60-, 90-, and 180-day post-intervention was 6.72 (95% confidence interval [CI], 4.77-9.46, I2 = 98%), 2.31 (95% CI 2.31-4.44, I2 = 92%), 2.84 (95% CI 1.39-5.79, I2 = 95%), 3.36 (95% CI 1.66-6.77, I2 = 98%), 3.19 (95% CI 1.44-7.08, I2 = 59%), 3.87 (95% CI 1.88-7.97, I2 = 0%), and 3.40 (95% CI 3.02-3.83, I2 = not applicable), respectively. The pooled minor complication rates of diarrhea, hypotension, nausea or vomiting, and pain associated with the procedure were 18% (95% CI 8-37%, I2 = 45%), 16% (95% CI 2-58%, I2 = 76%), 6% (95% CI 2-16%, I2 = 1%), and 7% (95% CI 2-21%, I2 = 17%), respectively. There was no major complication in the included studies. CONCLUSION: CT-guided single CPN can be performed safely and provides immediate analgesic efficacy although the amount of heterogeneity is characterized as large. Further investigation of its long-term analgesic efficacy is required.

Computed tomography-guided percutaneous biopsy for retroperitoneal lesions: a systematic review and meta-analysis.

The aim of this study is to perform a systematic review and meta-analysis of published studies to evaluate the efficacy and safety of computed tomography (CT)-guided percutaneous biopsy for retroperitoneal lesions. PubMed and the Cochrane Library were searched for English-language articles published up to October 2021 and reporting findings about patients with retroperitoneal lesions who underwent CT-guided percutaneous biopsy. The outcome measures assessed in this systematic review and meta-analysis are accuracy, false negative rate, and rate of minor and major complications. Heterogeneity among studies was evaluated by testing Cochran's Q and the inconsistency index statistics. Seven studies published from 1975 to 2021 were selected for the analysis of accuracy, false negative rates, and rate of major and minor complications. The pooled accuracy of CT-guided percutaneous biopsy for retroperitoneal lesions was 93.6% [95% confidence interval (CI), 88.1-96.6%], with high heterogeneity. The pooled false negative rate was 6.3% (95% CI, 3.3-11.7%) with high heterogeneity. Pooled rates of minor and major complications were 3.7% (95% CI, 1.6-8.6%) with moderate heterogeneity and 0.7% (95% CI, 0.4-1.1%) with low heterogeneity, respectively. CT-guided percutaneous biopsy for retroperitoneal lesions has been reported to have high accuracy with a limited rate of major complications.

18F FDG-PET/CT analysis of spread through air spaces (STAS) in clinical stage I lung adenocarcinoma.

OBJECTIVE: The purpose of this retrospective study was to investigate the utility of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F FDG-PET/CT) to predict spread through air spaces (STAS) in clinical stage I lung adenocarcinoma. METHODS: Between April 2020 and January 2022, 52 patients (55 lesions) who underwent surgery for clinical stage I lung adenocarcinoma were enrolled. The lesions were divided into two groups according to the presence of STAS. 18F FDG-PET/CT parameters, specifically the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), were calculated. The SUVmax, MTV, and TLG were compared between the two groups upon surgical pathological examination. Receiver operating characteristic (ROC) curve analysis was performed to identify a cut-off value. RESULTS: Nineteen lesions (35%) were positive for STAS and 36 lesions were negative for STAS. According to the presence of STAS, significant differences were detected in the SUVmax (5.21 [range 1.52-16.50] vs. 2.42 [range 0.74-11.80], p = 0.0040) but not MTV (3.44 [range 0.65-24.36] vs. 2.95 [0.00-20.07], p = 0.20) and TLG (7.92 [range 0.93-47.82] vs. 5.63 [0.00-58.66], p = 0.14). SUVmax had an AUC value of 0.74 (95% CI 0.61-0.87) with a sensitivity of 89.5% and specificity of 52.8% at a cut-off of 2.48. CONCLUSIONS: SUVmax rather than MTV and TLG were shown to be valuable indices for the prediction of STAS in clinical stage I lung adenocarcinoma.

Efficacy and safety of CT-guided cryoablation after lipiodol marking and embolization for RCC.

PURPOSE: To evaluate the safety and efficacy of CT fluoroscopy-guided percutaneous cryoablation (PCA) after lipiodol marking and embolization (LME) in patients with renal cell carcinoma (RCC). MATERIAL AND METHODS: This study included 29 patients (18 men, 11 women; mean age 69 years, range 22-89 years) with 42 RCCs. They underwent CT fluoroscopy-guided PCA after LME between March 2016 and March 2020. The mean tumor diameter was 21 mm (range 7-50 mm). LME was performed with lipiodol and gelatin particles. PCA was considered successful when the ice ball encapsulated the entire tumor and the margin was sufficient on post-ablation CT scans. RESULTS: LME was successfully performed in 39 of 40 tumors (97.5%). PCA after LME was successful in all 39 of 39 tumors (100%). During the follow-up period (mean 13.9 ± 12.1 months), one of the 39 tumors (2.6%) developed local tumor progression. A significant complication (reversible hypertensive crisis) was encountered in only one of 37 (2.7%) procedures. The mean eGFR was 64.2 ± 26.8 before and 63.3 ± 26.4 after PCA (p = .44). CONCLUSION: LME using iodized oil and gelatin particles to improve visualization of the RCC facilitated tumor localization on unenhanced CT images. PCA after LME might be a safe and effective for treatment in patients with RCC.

Artificially induced pneumothorax with a Veress needle for cryoablation of renal cell carcinoma.

Thermal ablative techniques are used increasingly to treat renal cell carcinoma (RCC). Percutaneous cryoablation of tumors at the upper pole of the kidney may result in pulmonary damage due to the intervening lung parenchyma. We treated two patients with RCC in the upper pole of the kidney by inducing pneumothorax with a pneumoperitoneum needle before proceeding to percutaneous cryoablation. The procedures, performed under computed tomography (CT) fluoroscopy guidance, resulted in complete tumor necrosis. There was no pulmonary damage.

A case of maxillary cancer treated by intra-arterial therapy using a steerable microcatheter.

We report on a 69-year-old man with locally-advanced left maxillary sinus cancer who underwent treatment with intra-arterial chemoradiotherapy. Angiography showed that the main feeding arteries were the left maxillary artery and the ophthalmic artery, arising from the internal carotid artery. Due to acute branching of the ophthalmic artery, conventional microcatheters could not be inserted. Using a steerable microcatheter, we were able to repeatedly administer chemoradiotherapy via the ophthalmic artery. The tumor has mostly disappeared after intra-arterial chemoradiotherapy, and the patient is still alive two years after treatment. A steerable microcatheter is very useful for acute-angled vascular branches.

Efficacy of arterial infusion of iodized oil on CT-guided cryoablation for renal cell carcinoma.

PURPOSE: To evaluate the effectiveness of the transarterial infusion of iodized oil and gelatin particles for marking before CT-guided percutaneous cryoablation (PCA) in patients with renal cell carcinoma (RCC). MATERIAL AND METHODS: This study included ten patients (seven men, three women; mean age 53 years) with 13 RCCs between July 2016 and September 2017. The transarterial infusion of iodized oil and gelatin particles was considered successful when iodized oil accumulated in the target area on CT. CT value of the tumor before and after marking was measured and two diagnostic radiologists evaluated the visualization scores by using a five-point scale (5 = excellent to 1 = invisible). RESULTS: Preoperative marking was successful in all 13 tumors; the median visualization score was 5 post-lipiodol marking and 4 at the time of PCA. The mean CT density was 597 ± 371 Hounsfield units (HU) just after marking and 437 ± 234 HU at the time of PCA. All 13 CT-guided PCA procedures were successful. There were no significant complications. During follow-up (median 11.5 ± 7.0 months) there were no local recurrences. CONCLUSION: As the transarterial infusion of iodized oil and gelatin particles improved RCC visualization on CT, its delivery before CT-guided PCA may improve its safety and success rate in patients with RCC.

Protection from injury of organs adjacent to a renal tumor during percutaneous cryoablation.

Renal cryoablation has become accepted as treatment for small renal tumors as an alternative to surgery. However, parallel with the increase in the use of this therapy, there also has been increases in the number of reports of complications related to renal cryoablation. One potential complication is injury to important non-renal structures adjacent to the ablated renal tumor, such as the colon, duodenum, ureter, psoas muscle and so on. To prevent injury of adjacent organs, separating organs from the tumor is desirable. Over the past 15 years, several techniques have been developed to protect against injury of organs adjacent to renal tumors that are targets of cryoablation. The most commonly used technique for this purpose has been hydrodissection. Others include dissection with gas, balloon dissection and probe traction. To avoid injury of a ureter running near the renal tumor, pyeloperfusion is known to be useful. The rate of cases necessitating avoidance of organ injury by using these techniques is relatively high. In some cases, more than two techniques are combined. In the present review, we provided an overview of techniques currently available to protect against organ injuries, and discussed the advantages and disadvantages of each technique.

Time-Dependent Effects of Cryoablation for Renal Tumor on Overall and Split Renal Function.

PURPOSE: To evaluate the influence of percutaneous cryoablation for renal cell carcinoma on function of the affected kidney. MATERIALS AND METHODS: Between June 2016 and September 2017 at our institution, 12 inoperable patients underwent 15 cryoablation sessions for 17 small renal tumors. Of these, 9 patients who underwent 11 sessions of cryoablation were the focus of this study. For those patients, time-dependent changes in postoperative renal function were investigated by a retrospective review of clinical records. Evaluated were the estimated glomerular filtration rate (eGFR) and scintigraphy using 99m technetium-mercaptoacetyltriglycine (99mTc-MAG3) before and 1 week, 1-2 months, and more than 6 months after cryoablation. RESULTS: Mean baseline eGFR was 76.88 ± 29.82 mL/min/1.73 m2 (mean ± standard deviation; range, 23.4-112.5). Mean eGFR 1 week, 1-2 months, and more than 6 months after cryoablation were 74.56 ± 26.68 mL/min/1.73 m2 (21.0-101.1), 69.5 ± 25.28 mL/min/1.73 m2 (24.1-105.6), and 75.08 ± 26.25 mL/min/1.73 m2 (29.0-107.3), respectively. Changes were statistically insignificant (P = .6044, P = .6699, and P = .9038, respectively). Regarding split renal function, the mean baseline contribution of the affected kidney determined by 99mTc-MAG3 was 47.27% ± 6.14 (38.8%-57.0%). Mean contributions of the affected kidney 1 week after, 1-2 months after, and more than 6 months after cryoablation were 44.40% ± 5.37 (38.3%-53.6%), 44.57% ± 6.52 (34.35%-55.0%), and 45.41% ± 7.77 (34.4%-56.5%), respectively. Differences from baseline were significant for the earliest 2 periods (P = .0473 and P = .0334, respectively) but not the later period (P = .2532). CONCLUSIONS: Results suggested that total renal function does not worsen after cryoablation; however, function of the affected kidney worsened after cryoablation but later partially recovered.